community profile

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community profile

2 012 Ga l l ati n County
Community
Health
P R O F ILE
PARTNERS
The key project partners
have a vested interest
in the Healthy Gallatin
Initiative, and have been
integral in moving this
process forward.
In addition to the key partners, the organizations below have invested time and resources and have been a vested interest in this process. This process is only as strong as the energy and commitment from the community. Thank you for
your support!
Acorn Pediatrics
AIDS outreach
Alcohol Drug Services of Gallatin Co.
Belgrade Chamber of Commerce
Belgrade City Council
Belgrade Public Library
Belgrade Public Schools
Blue Cross Blue Shield
Board of Health
Bozeman Deaconess Health Services
Bozeman Deaconess Hospital
Bozeman GLBT Resource Center
Bozeman School District
Bozeman Senior Center
Bridgercare
Cancer Support Community
Career Transitions
Central Service Area Authority
City of Three Forks
Community Health Partners
Community Mediation Center
County Planning & Community Development Office
Department of Health and Human Services
Family Outreach
Gallatin City-County Health Department
Gallatin County Attorney’s Office
Gallatin County Emergency Management
Gallatin County Sherriff
Gallatin Mental Health Center
Gallatin Valley Farm to School
Gallatin Valley Land Trust
Gallatin Valley Mental Health Local Advisory Council
Gallatin Valley YMCA
Greater Gallatin United Way
This report was published December, 2012
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PARTNERS
HAVEN
HealthWorks
Help Center
Highgate Senior Living
Human Resource Development Council
Job and Social Services of West Yellowstone
Job Service
Love, Inc
Manhattan City Council
Mental Health America of MT
Mint Dental Studio
Montana Peer Network
Montana State Legislature
Montana State University
Montana Tobacco Prevention Advisory Board
MSU College of Nursing
MSU Health and Human Dev
MSU Local Government Center
MSU Student Health Service
MT chapter of the American Academy of Pediatricians
National Alliance for Mental Health
Nutrition and Physical Activity Program
Rocky Mountain Development Council
St. James Episcopal
The Montana Dental Association
Three Rivers Clinic
Thrive
We Care Chiropractic
West Yellowstone City Council
West Yellowstone News
Western Transportation Institute/Safe Routes to School
WIC
Willing Workers Ladies Aid, Inc.
Women in Action
CONTENTS
Partners...........................................................................................................................................................2
Introduction/Executive Summary . . ...........................................................................................................4
Understanding Social Determinants of Health..................................................................................7
Mobilizing for Action through Planning and Partnerships��8
Gallatin County Vision................................................................................................................................9
Community Themes and Strengths Assessment..................................................................................10
Methodology..................................................................................................................................................10
Overarching Results of Community Themes and Strengths.. ..................................................................................11
Local Public Health System Assessment.. ..............................................................................................33
Methodology. . .................................................................................................................................................34
Forces of Change Assessment.. ...............................................................................................................36
Methodology. . .................................................................................................................................................36
Community Health Status Assessment...................................................................................................38
2011 PRC Community Health Survey..................................................................................................................38
Community Health Status Assessment INDICATORS.............................................................................39
CONTENTS
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Introduction
and Background
INTRODUCTION
What is health? How can we measure it? How can we improve it? How does it matter to us, and to our families?
For individuals, the answers to the questions above are as unique and wide-ranging as the genetics of our personal DNA, the results of
our last medical tests, and the diseases that we happen to acquire. For the individual, these are personal questions usually discussed in exam
rooms or at home with people we love and trust.
But the questions above cannot be adequately answered without also acknowledging that our health is fundamentally affected by our
community. Is our water clean? Is the air healthy? Do our children attend affordable day care centers that serve healthy foods, keep kids active,
and require immunizations? Can we afford health insurance? How many people rely on the emergency room as their main health care provider?
Is the person driving toward us on the highway intoxicated?
These are some of the questions that impact all of us every day. Every community chooses to confront these challenges in different ways
that reflect the varying sensibilities and priorities of the people who live within the community. What is constant, however, is that a community
is better equipped to make choices and set priorities when its residents are well-informed about the health status of the community.
The Community Health Assessment contained on the following pages provides some of the information necessary to make informed
choices and set priorities. This document is a summary of work that began more than one year ago to gather data and consult with county
residents and community leaders to learn more about the health of our community. This process included more than 20 community meetings,
an extensive telephone survey of 700 residents, an examination of existing health data, and consultations with health professionals and human
service organizations from across Gallatin County.
Three organizations – Gallatin City-County Health Department, Bozeman Deaconess Hospital, and Community Health Partners – came
together to undertake this assessment. For all three organizations, this assessment represents a building block from which to pursue a common mission: better health for our community.
The pages that follow contain a wealth of information that will be relevant to different people and organizations in different ways. What
did we learn? Some of the most significant issues uncovered include:
• More than 1 in 5 adults in Gallatin County under the age of 65 do not have health insurance.
• Gallatin County residents (and Montanans) are less likely to use a seatbelt and more likely to die in a car accident than other Americans.
• The suicide rate in Gallatin County is 60 percent higher than the national rate.
• Substance use and abuse is prevalent and a growing concern, particularly in Bozeman.
• Parents all over Gallatin County worry about a lack of healthy, productive activities for their children, particularly adolescents.
The organizations that sponsored this assessment intend to share its contents widely so that Gallatin County residents and organizations
can use it in ways that make sense for them. We also have begun an effort to facilitate a community effort to write a Community Health Improvement Plan to identify high-priority issues and formulate a plan to build awareness and drive improvements. By doing so, we hope that
this document will help build healthier communities for the residents within Gallatin County.
Health Officer
Gallatin City-County Health Department
BACKGROUND
Gallatin County is located in Southwestern Montana and
borders Wyoming, Idaho and Yellowstone National Park to
the south. From the outside, Gallatin County has a reputation of being an outdoor-enthusiast’s destination. Worldclass fly-fishing can be found within the county, and skiers
come from near and far to enjoy the slopes in the winter.
This unique and beautiful area does not come without its
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INtroduction & background
health challenges for residents.
This document serves as a summary report of a comprehensive community health assessment (CHA), conducted between June 2011 and August 2012. It was conducted by the
Gallatin City-County Health Department, in collaboration with
Bozeman Deaconess Health Services and Community Health
Partners, and with a large degree of community participation.
KEY FINDINGS
In the following pages of this report, you will find a great deal of information that has enabled the Healthy Gallatin folks
to begin to understand the health of the county. Below are some issues that stood out in the data that was collected, and
that Healthy Gallatin believe are most impactful to the health of the residents of Gallatin County. Residents can find this full
report as well as the Community Health Improvement Plan at www.healthygallatin.org.
• Barriers to Access: As the Latino
population grows, language barriers
become an increased challenge to
access to health care. This contributes to significantly poorer health
status among Hispanic residents:
71% of Hispanic residents in Gallatin
County say that in general their
health is poor. Furthermore, many
residents have to travel far distances
for certain health services, and, especially as gas prices rise, people
are less willing to travel.
• Engaging youth is important to preventing risky behaviors: The challenge of engaging youth was mentioned throughout the assessment.
Communities wanted to provide the
youth with more healthy activities in
order to prevent them from turning
to risky behaviors, such as alcohol,
drugs, and sex.
• Gallatin County has a large population lacking health insurance:
Residents in rural areas and throughout the county consider access
to health services a major health
challenge. Twenty-two percent of
Gallatin County residents are uninsured, and many more are underinsured. This rate is nearly twice as
high for those living below 200% of
the federal poverty level. Insurance
is a major barrier to accessing preventable health services.
• Health organizations can work together more to increase referrals
and maximize impact. A challenge
heard throughout the assessment
was collaboration between human
service organizations to refer people
between organizations and improve
health.
• Mental health: Communities in
Gallatin County experience mental
health challenges regularly. The suicide rate in Gallatin County is almost
60% higher than US suicide rates.
The Mobilizing Action through Planning and Partnership
(MAPP) process was undertaken with broad support and
was possible through a large degree of community participation. By following the MAPP process, four assessments
were conducted in order to create a broad base of information. These four assessments were:
• Community Themes and Strengths Assessment (CTASA)
Stigma against mental health issues
and against seeking mental health
services are barriers to receiving
care.
• Sense of community is important
to quality of life: All communities
voiced a desire to increase community activities. It is this sense of
community that was viewed as an
asset, but also an area of opportunity. Communities wanted increased
knowledge of community events
and services and more community
gatherings.
• Substance Abuse contributes to
costly problems: Twenty percent
of residents admit to binge drinking, which is associated with teenage pregnancy, sexually transmitted diseases, domestic violence,
motor vehicle crashes, and crime.
Furthermore, 9.5% of adults use
smokeless tobacco, which is much
higher than national rates.
Each of the four MAPP Assessments gathered both
qualitative and quantitative data. Through careful review,
areas of celebration and areas of opportunity were selected
from each of the assessments, and are summarized in the
tables below. In the following pages of this report, detailed
descriptions of how these issues arose, the process that was
conducted, and the stakeholders that participated in each
assessment will be discussed.
• Local Public Health System Assessment (LPHSA)
• Forces of Change Assessment (FOCA)
• Community Health Status Assessment (CHSA)
This unique and beautiful area does not come
without its health challenges for residents.
introduction & background
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Introduction
and Background
AREAS OF CELEBRATION
CTASA
Diagnosing/Investigating Public Health Issues
Natural Resources
Safety
Areas of Opportunity
Affordable Housing
Agency Communication
Bilingual Services
Communication, integration & networking
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CTASA
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Coordination of personal health and social services
Economic Development/Seasonal Economy
Link people to health services/access
Local Food
Mental Health
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Mobilize Community Partnerships
Monitor Health Status
Public Health System Infrastructure
Substance Abuse
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LPHSA
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Tobacco Usage
Transportation
Unemployment/Underemployment
Wealth Disparity
Youth Engagement
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introduction & background
CHSA
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Enforcement of Public Health Laws
Environmental Preservation
FOCA
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Development of Public Health Policies and Plans
Education
LPHSA
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FOCA
CHSA
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Understanding the
Determinants of Health
Determinants of health are conditions in the environments
in which people are born, live, learn, work, play, worship,
and age that affect a wide range of health, functioning, and
quality-of-life outcomes and risks. Conditions (e.g., social,
economic, and physical) in these various environments and
settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.” In addition to the
more material attributes of “place,” the patterns of social
engagement and sense of security and well-being are also
affected by where people live. Resources that enhance
quality of life can have a significant influence on population
health outcomes. Examples of these resources include safe
and affordable housing, access to education, public safety,
availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins. 1
Understanding the relationship between how population groups experience “place” and the impact of “place”
on health is fundamental to the determinants of health—including both social and physical determinants.
Examples of social determinants include:
• Availability of resources to meet daily needs (e.g., safe
housing and local food markets)
• Social norms and attitudes (e.g., discrimination, racism,
and distrust of government)
• Access to educational, economic, and job opportunities
• Exposure to crime, violence, and social disorder (e.g.,
presence of trash and lack of cooperation in a community)
• Access to health care services
• Quality of education and job training
• Availability of community-based resources in support of
community living and opportunities for recreational and
leisure-time activities
• Transportation options
• Socioeconomic conditions (e.g., concentrated poverty
and the stressful conditions that accompany it)
• Residential segregation
• Language/Literacy
• Public safety
• Access to mass media and emerging technologies (e.g.,
cell phones, the Internet, and social media)
• Social support
• Culture
In Gallatin County, results from the community health status assessment consistently show people who live at or below 200%
of the Federal Poverty Level are more likely to experience poor health, less likely to see a doctor or access prescription
medications and report ‘fair or ‘poor’ mental health. These same people are less likely to receive preventative screenings
for cancer and access healthy foods. These are just a few examples.
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http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39
understanding the determinants of health
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Mobilizing for Action through
Planning & Partnerships
Mobilizing for Action through Planning
and Partnerships (MAPP) is a community-driven strategic planning process for improving community health.
Facilitated by the Healthy Gallatin
core team with planning and assistance from the MAPP Committee, this
framework helps communities apply
strategic thinking to prioritize public
health issues and identify resources to
address them. MAPP is not an agencyfocused assessment process; rather, it
is an interactive process that can improve the efficiency, effectiveness,
and ultimately the performance of local public health systems. Four MAPP
Assessments provide a complete
MAPP
picture of health strengths and opportunities in Gallatin County.
The four assessments conducted as
part of the process include:
1. Community Themes and
Strengths Assessment
2. Local Public Health System
Assessment
3. Community Health Status
Assessment
4. Forces of Change Assessment
MAPP is a shift in how we think
about public health planning. It is
a shift from operational to strategic
Your Community Roadmap to Health!
A
Healthier
Community
AC T I O N
CYCLE
Formulate Goals & Strategies
Evaluate Implement Plan
Identify Strategic Issues
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MAPP
ASSESSMENTS
OUR
V I SI ON
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planning; from a focus on the agency to a focus on the community and
the entire public health system, from
needs assessment to an emphasis on
assets and resources; from a medically
or service-oriented model to a model
that encompasses a broad definition
of health; and from an “agency knows
all” perspective to the belief that “everyone knows something.”
Simply put, MAPP is a way of
bringing everyone’s collective wisdom
together. By gathering all of the assets
and resources within the community,
the community is able to determine
how best to use all of the wisdom to
create a healthier community.
mobilizing for action through planning & partnerships
1. Community Themes and Strengths
2. Forces of Change
3 Community Health Status
4 Local Public Health System
Gallatin County Vision
On a cold Friday afternoon in January, 2012, over 90 community members met in the Bozeman Public Library to create a
vision for the Healthy Gallatin Initiative.
We are committed to making Gallatin County an active,
thriving community that values the health of its people.
We seek to promote healthy choices for all residents
through open communication, collaborative relationships and affordable health resources.
We are dedicated to building partnerships and coalitions
to improve the overall community health without stigma
or judgment. We support and connect all groups, organizations and individuals that are committed to making
Gallatin County a healthy place to live, work, play and
grow old.
Pursuing this vision requires the following principles:
• Health resources are accessible and inclusive to everyone
• People are informed, connected and empowered
»» To improve their own health and that of their families
»» To engage in larger conversations about health and
health disparities
• Organizations and practitioners connect and collaborate
across our communities
• Healthy communities include infrastructure that encourages healthy lifestyles
Gallatin County vision
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Community Themes and
Strengths Assessment
The Community Themes and Strengths Assessment provides a deep understanding of the issues residents feel are important. Throughout this assessment, community members shared their thoughts, opinions and concerns about health issues
where they live. A large amount of qualitative data was gathered from this assessment.
METHODOLOGY
The Community Themes and Strengths
Assessment followed a process
called “study circles”, using a facilitation guide that was modified from
Everyday Democracy. The study circle
model allowed for citizen engagement
in each community to identify unique
and over-arching health themes and
strengths. Community members were
asked to participate in a series of
meetings where the conversations
revolved around the broad idea of
health. In each community between
eight and 35 residents participated in
the conversations. The opinions expressed during the study circles reflect
the views of the participants and may
not be an accurate representation of
the community that was assessed.
The study circles begin with a focus on connecting with the community through introductions and sharing
thoughts, experiences, and stories.
Questions guided conversations that
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explored community assets as well
as challenges that impact individual
health and the health of their communities. Example questions included, “What does a healthy community
look like?” “What makes this community a good and healthy place to
live?” and “How do we accomplish
the good work that gets done in our
community?”
The study circles spend time discussing the community’s most important challenges, and questions guide
the participants to think about the
causes behind the challenges and the
obstacles to addressing the challenges. Many of the issues that came up
were social and environmental determinants of health. During the Action
Forum of the study circles, participants
were asked to identify and prioritize
the themes discussed throughout the
study circles.
MANHATTAN
WEST
YELLOWSTONE
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West Yellowstone Action Forum
BELGRADE
GALLATIN
GATEWAY
3 meetings
3 meetings
BOZEMAN
BIG SKY
3 meetings
1 meeting
4 meetings
3 meetings
3 meetings
http://www.everyday-democracy.org/en/Index.aspx
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Bozeman Action Forum
community themes and strengths assessment
Overarching Results of Community Themes and Strengths
Each community within Gallatin County has health issues that are unique to their populations, but many issues also overlap.
Each community prioritized the issues in the final study circles meeting. In the table below you can see how community
priorities compare. Some of these issues were combined for the Key Findings on page 6.
THREE
FORKS
MANHATTAN
Youth
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Communication,
integration & networking
Health Care Infrastructure
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Themes
Economic Development
Seasonal Economy
Mental Health
Transportation
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WEST
YELLOWSTONE
Local Food
Affordable Housing
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Environmental
Preservation
Public Health
Communication
Unemployment &
Underemployment
Bilingual Services
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Link people to health
services/access
Substance Abuse
Local Government
GALLATIN
GATEWAY
BELGRADE
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BOZEMAN
BIG
SKY
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Due to the format of the study circles, all of the questions regarding health were left open to interpretation from the participants. The conversations were not always framed from existing data. However, many of these issues have quantitative data
related to community challenges. Please refer to the indicators and data from the Community Health Status Assessment
beginning on page 38.
community themes and strengths assessment
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BELGRADE
community profile
The Belgrade community is located
in the central region of the Gallatin
Valley. Belgrade lies about 10 miles
northwest of Bozeman. Belgrade is
bisected by the I-90 Interstate and
Montana Rail Link Line. The community is growing rapidly with a lot of
young families.
Belgrade has many strengths
and assets which promote healthy
lifestyles. While the community has a
“small-town-feel,” many of the amenities of a larger city are present or available in neighboring communities.
DEMOGRAPHICS
Based on the 2010 census, the population of Belgrade was 7,389. According
to the census, 33% of the population
of Belgrade is living below 200% of
the Federal Poverty Level. Belgrade
has a very young population: 28% of
Belgrade’s population is under the
age of 18, which is the highest in the
county, and 6% of Belgrade’s population is over the age of 65, which is the
lowest in the county.
Methodology
Because Belgrade is separated by
Interstate-90, two study circles were
held simultaneously on opposite sides
of town to increase accessibility. The
two study circles joined together for
the third session, for prioritization
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belgrade themes AND STRENGTHS
and the action forum. Thirty-eight
Belgrade residents participated in the
study circles, including representation
from healthcare providers, the Latino
Community, civic organizations, faith
institutions, the senior community and
the school system.
assets
The following is a list of assets that exist in Belgrade.
• (more) Affordable housing
• Belgrade Special Event Center
• Community Gatherings
• Farmers market
• Health services
• Kids sports programs
• Library & Library programs
• Outdoors
• Polite and caring community
members
• Safe place for kids
• School system
• Splash park
• Small size and central location
“I love living in Belgrade. All the big city
amenities are near, but it’s a small town feel.”
Identifying Themes and Addressing Challenges
In each community there are challenges that impact the health of the residents. The following themes were identified as
areas that the participants believed would have a substantial and lasting impact on the health of their community.
• Access-Mental health: Youth and non-English
speakers experience many barriers to receiving mental
health services. A stigma against needing counseling
and confidentiality issues prevent many youth from accessing mental health services. Non-English speakers
are unaware of many services available and the lack of a
Spanish-speaking counselor makes many available counseling services unusable.
• Bilingual services: The Latino community cannot
utilize certain services, including parenting classes, mental and personal health services, community services, and
day care because they are not available in Spanish.
• Communication: Communication of community activities and available services is important to forming a
Belgrade identity and maintaining services that are located within the community.
• Connected community: The Belgrade community
is split in half by Interstate-90 and the Montana Rail Link
Line, which makes people less connected to the community. Furthermore, since many Belgrade residents work in
Bozeman, Belgrade is viewed as simply a place to sleep,
and less as a community.
• Economic development*: Economic Development
in Belgrade is important to revitalizing Main Street so
storefronts are open and new entertainment facilities, like
a movie theatre or bowling alley, may become available.
• Infrastructure: Because the Montana Rail Link Line
cuts through Belgrade, longer trains will further hold up
traffic and emergency vehicles. Sewer and water systems need improvements to grow with the increasing
population.
• Youth*: Homeless youth without adult supervision contribute to serious drug and alcohol abuse, teen pregnancy, and high-school drop-out. A lack of summer and afterschool programs or employment and community service
opportunities leaves youth unconnected to the community and disempowered. Youth are more hesitant to access health services, which include mental and reproductive health, and contributes to poor health outcomes.
• Transportation: Transportation is important for
youth without licenses and for those who can’t afford to
drive with increased gas prices. Currently the Streamline
is limited and the latest bus is 6:30 PM.
“It’s a great community, but people are not
engaged... they see it as a place where their
house is, not a community”
* Challenges that were prioritized by community members
belgrade themes and strengths
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BELGRADE
belgrade public health system
Below is a visual representation of the organizations and associations that contribute to the health and well-being of the
community of Belgrade.
Community
Health Partners
Volunteers
Bozeman
Deaconess
Belgrade Clinic
Belgrade Chamber
of Commerce
Rotary
Club
Lion’s Club
& Leo Club
Bridgercare
Fire Department
Lee & Dad’s
Belgrade
School System
THRIVE
Belgrade 4-H
Town Council
Gallatin Valley
Food Bank
BELGRADE
COMMUNITY
Neighbors
Career Transitions
Belgrade
Police
Department
Belgrade
Senior Center
Belgrade
Urgent
Care
Belgrade Library
Faith Institutions
in Belgrade
Belgrade
Youth Forum
HRDC
Belgrade Kiwanis
& Key Club
Belgrade Action Ideas
• Bring mentor program to Belgrade Schools:
Belgrade school administrators are looking into mentor
programs to benefit at-risk youth. The program is still in
need of volunteer mentors and funds to get the program
running.
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belgrade themes AND STRENGTHS
• Build a Recreation Center for youth &
community activities: Participants envisioned a
recreation center for people of all ages, youth to seniors,
to congregate throughout the day to provide healthy
activities, a more cohesive Belgrade community, and a
space for afterschool and summer activities.
BIG SKY
community profile
Methodology
The Big Sky Community is an unincorporated, census-designated place
(CDP) in Gallatin and Madison counties. The primary industry is tourism,
due mostly to ski resorts. The Gallatin
River provides activities for rafters and
kayakers and is a designated Blue
Ribbon trout stream. Trails throughout
the community, for both winter and
summer recreation, promote tourism during the offseason and provide
healthy activities for residents. Health
services include a dentist, a small
medical clinic, a physical therapist,
chiropractor, and a pharmacy.
The community of Big Sky has
many strengths and assets which encourage healthy lifestyles. The public
school system is expanding to provide
more athletic options as well as arts
and music programs. As a young town
with a young population, residents are
very active, and trails and bike paths
are available for physical activity and
community activities.
Because of Big Sky’s seasonal economy, residents could not commit to
three weeks of study circles in July
and August, so study circles in Big Sky
occurred over one session in July. Ten
Big Sky residents participated in this
session: representation included local
healthcare providers, local non-profits, resort management and seasonal
resort employees.
DEMOGRAPHICS
Based on the 2010 census, the population of Big Sky was 2,308. Furthermore,
according to the Census, 33% of the
population lives below 200% of the
Federal Poverty Level and there is
a 9% unemployment rate. Big Sky
has the highest proportion, 55%, of
residents with a Bachelor’s degree or
higher.
assets
The following is a list of assets that exist in the community of Big Sky.
• Access to clean outdoors
• Arts & theatre
• Dedication to Big Sky
• Education
• Healthy & pro-active residents
• Healthcare providers
• Library
• Safe place for kids
• School system
• Splash park
• Small size and central location
• Low population density
• Law enforcement
• Non-profit childcare
• Outdoor recreation
• Sewer and water infrastructure
• Spiritual health
“This community works
together... it seems like
everyone has your back.”
• Tourism
big sky themes AND STRENGTHS
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BIG SKY
areas that the participants believed would have a substantial and lasting impact on the health of Big Sky.
• Affordable Food: The cost of living is higher in Big
Sky than in the rest of the county. Healthy and fresh food
is difficult to afford, which makes eating healthy unavailable. Residents with dietary constraints, including diabetes, are especially hindered with the higher prices of
food.
• Affordable housing: Housing is very dense and
very expensive. Lower income housing is unavailable.
• Education: The education system is expanding, but
participants envisioned increased school sports, arts and
music programs. Since Big Sky is a newer school district,
there is room for improvement.
• Environmental stewardship: Big Sky is unique
because of the wildlife and environment, but these are
threatened without environmental stewardship. There
are few opportunities to recycle, but making it easier to
be evironmentally mindful would increase environmental
stewardship.
• Healthcare access: High uninsurance rates makes
healthcare less affordable, despite the numerous service
providers in the community. Seasonal employees especially lack health insurance, causing great burdens to receiving care. Big Sky does not have advanced healthcare
or in-patient mental health services.
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• Local governance: Because Big Sky is unincorporated, addressing challenges like substance abuse is
more difficult. Local governance is important to building
a cohesive community.
• Stable economy, year-round & local*: People
make a living 8 months a year, and are dependent on the
ski season and economic health of the US. A high unemployment rate contributes to high stress and substance
abuse. Employers hire personnel from outside of Big Sky
because people are willing to come from all over the
world and live in poor conditions.
“Health insurance here is like a jar in a bar
when someone needs something, but that
hurts everyone.”
* Prioritized by community members
Big Sky Public Health System
community of Big Sky.
Big Sky Chamber
of Commerce
Medical Clinic
of Big Sky
Big Sky
Community
Corporation
Volunteers
Big Sky Fire
Department
Big Sky
Search and Rescue
Christine
Adams, LCSW
Lone Peak
High
Ophir School
District
Bozeman
Deaconess
Pharmacy
BIG SKY
COMMUNITY
Big Sky Owners
Association
Gallatin Family
Medicine
Lone Peak
Physical Therapy
Big Sky Chapel
Soldiers
Chapel
Women in
Action
Neighbors
Morningstar
Learning Center
BIG SKY Action Ideas
• Curbside recycling: To make recycling easier so
more residents are able to participate and more recyclable items are recycled.
• Create a community garden: So that affordable,
healthy food is available.
• Increase recreation activities: Activities for all
ages and social activities to reduce substance abuse and
high-risk behaviors.
•
17
Bozeman
community profile
The city of Bozeman is located in
the central Gallatin Valley, and is
the fourth most populated city in
Montana. Bozeman is also the county
seat of Gallatin County. Bozeman is a
college town, home to Montana State
University, making it a hub for research
and development. Numerous nonprofits in the area provide opportunities for arts and culture and work to
protect the environment and promote
health.
The community of Bozeman has
many strengths and assets which encourage healthy lifestyles. Bozeman’s
downtown is a hub for community
gatherings and entertainment. The
education system and Montana State
University provide great education
and develop human capital as a resource. Furthermore, spaces such as
parks, trails and bike paths are available for community activities and
physical activity.
DEMOGRAPHICS
Based on the 2010 census, the population of Bozeman was 37,280. Thirtyeight percent of residents live below
200% of the Federal Poverty Level,
which is the second highest rate in the
county.
Methodology
Study circles in Bozeman occurred
over three weeks in July. Twenty-eight
18
•
Bozeman themes AND STRENGTHS
Bozeman residents participated in the
study circles, and included representation from Montana State University,
civic organizations, members of the
senior community and representation
from the school system.
assets
The following is a list of assets that exist in the community of Bozeman .
• Civic groups
• Civic pride
• Clean environment
• Community activities
• Desire to be healthy
• Diversity
• Dynamic local media
• Education system
• Friendly community
• Health resources
• Human capital
• Interfaith alliance
• Library
• Opportunity to participate in
politics
• Parks and Recreation
• Vibrant main street
“Bozeman is not resource poor: we have a lot of human capital.”
• Access to transportation*: Increasing the reach
of public transportation and the connectivity of bike trails.
The streamline provides transportation options around
Bozeman, but does not provide service on Sundays or
regular and expanded transportation into Belgrade.
• Environmental preservation: Air and water
quality is threatened across Gallatin County because of
increased coal traffic and proximity to hydrolic fracturing
in the Bakkan oil fields. Climate change and a growing
population may affect the water supply.
• Affordable housing: A lack of affordable housing is increasing homelessness rates in Bozeman and
throughout the county.
• Youth engagement*: Many recent college graduates are unemployed with high levels of debt. Many
middle and high school students are cut from sports and
cannot find employment. Opportunities for community
service and political activism would empower youth and
provide healthy activities.
• Comprehensive health system (including
mental health) that’s affordable and welcoming to all*: The health system has to reach out
to vulnerable populations and ensure people feel empowered to access services.
• Public health education: A communication strategy by the public health system to educate the public
about how to stay healthy and how to access available
services would be an asset to the community. Education
about mental health and social services could also reduce the stigma around accessing these services.
• Classism/ageism: Individuals living in poverty and individuals over the age of 45 may experience discrimination when looking for employment.
• Connecting people to services: Health resources exist and are available, but the challenge is people
using them.
“We disregard our poverty and fail to
acknowledge it.”
bozeman themes AND STRENGTHS
•
19
Bozeman
bozeman public health system
community of Bozeman.
Bozeman Deaconess
Hospital
Volunteers
Bozeman Fire
Department
EMT
Montana State
University
City
Commission
Cancer Support
Community
Human Resource
Development
Council (HRDC)
Rotary
Club
KUSM / YPR
/ KGLT
MSU Extension
Retired and
Senior Volunteer
Program (RSVP)
Gallatin Mental
Health Center
Neighbors
BOZEMAN
COMMUNITY
Greater Gallatin
County Homeless
Action Council
Bridgercare
Bozeman
Police
Community
Museum of
Health Partners the Rockies
Eagle Mount
Senior
Center
Bridger Ski
Foundation
Bozeman
School System
Thrive
Gallatin Valley
Land Trust
Faith Community
Sacks Thrift
in Bozeman
Store
Gallatin Valley
Bike Club and
Bike Kitchen
Downtown
Bozeman
Association
bozeman Action Ideas
• Outreach to vulnerable populations: Help
people feel welcome at health offices and access needed
services.
20
•
bozeman themes AND STRENGTHS
• “No wrong door”: Ensure that service providers
are knowledgeable about existing services so people in
need of additional services can be referred. Service providers need to work together to ensure Bozeman residents receive the assistance they need.
Gallatin
Gateway
community profile
Methodology
Gallatin Gateway is an unincorporated community at the entrance to the
Gallatin Canyon. Gallatin Gateway lies
12 miles southwest of Bozeman. The
historic Gallatin Gateway Inn, as well as
the community’s access to the Gallatin
National Forest makes Gateway a
destination for tourists. Additionally,
agriculture and farming are important
industries in the community.
Gallatin Gateway has many
strengths and assets which promote
healthy lifestyles. Residents enjoy a
small town feel with easy access to
the outdoors. Trails and parks are easily accessible for community activities
and physical activity. Furthermore,
many dedicated community groups
promote health and education in
Gateway. A community center is available for community events like a quarterly community potluck dinner.
Study circles in Gateway occurred over
three weeks in June. Fourteen Gallatin
Gateway residents participated during
the three study circles. The attendees
of these sessions included families,
representation from the senior community and civic organizations.
DEMOGRAPHICS
Based on the 2010 census, the population of Gallatin Gateway was 856, of
which 17% is living below 200% of the
Federal Poverty Level. Eleven percent
of Gallatin Gateway residents have
not graduated high school, which is
the second highest in the county.
assets
The following is a list of assets that exist in Gallatin Gateway.
• Bike Path
• Civic engagement
• Concerned citizens
• Gallatin Gateway Community
Center
• Gateway Inn & Stacey’s: tourism
• Health-oriented school
• Little Bear Schoolhouse Museum
• Outdoors: mountains and river
• Parks
• Quarterly Community Dinners
• Safe community
• Small community feel
“I get up every morning & look out my window at the
mountains and the air is fresh. That is health.”
gallatin gateway themes AND STRENGTHS
•
21
GALLATIN
GATEWAY
areas that the participants believed would have a substantial and lasting impact on the health of Gallatin Gateway.
• Access to food locally*: There is no grocery
store within Gallatin Gateway, and transportation to access food is limited/non-existent. Access to food is especially difficult for low-income families and individuals.
• Access to healthcare: Gateway does not have
any health services located within the community.
Transportation to and from Bozeman for health reasons
is important, especially for the elderly and low-income
individuals.
• Community communication and coordination*: The lack of a singular communication channel
within the community makes sharing news and advertising community events and services difficult.
• Education: A high home-school rate creates challenges with the transition between home-school curriculum
and public school.
• Transportation: Transportation is important since
Gallatin Gateway does not have many local service options. If youth do not have parents to drive them to and
from activities, they cannot attend, and high school students are unable to take first period class at Bozeman
High School because of the bus schedule.
“There is nothing for getting into town to see a doctor... let alone to go grocery shopping.”
22
•
GALLATIN GATEWAY Public Health System
community of Gallatin Gateway.
Volunteers
Gateway Fire
Department
Gateway Youth
Group (GYG)
Gallatin
Gateway
School
Parents in
Education
GALLATIN GATEWAY
COMMUNITY
Faith Institutions
in Gateway
4-H Club
Neighbors
The Foundation
Willing Workers
Ladies Aid (WWLA)
GALLATIN GAteway action ideas
• Coordinate with streamline and Galavan:
To increase transportation to needed services and arrange a morning and afternoon activity bus for youth.
• Gateway Bulletin Board: The creation of a physical or virtual Gallatin Gateway Bulletin Board to publicize
events, rideshares, etc.
• Access to food locally: Increase access to local
food and access to food locally.
•
23
Manhattan, Churchill,
& Amsterdam
community profile
Methodology
The Manhattan, Churchill and
Amsterdam communities are located
in the central region of the Gallatin
Valley. The communities of Churchill
and Amsterdam lie almost 9 miles
south of Manhattan. Manhattan is bisected by Montana Rail Link line and
the East Gallatin River flows just east
of the town. Churchill and Amsterdam
communities have a long and proud
agricultural history, and farming is still
prevalent today.
The communities of Manhattan,
Churchill, and Amsterdam have many
strengths and assets which promote healthy lifestyles. The school
and education system is a source of
community pride, which attracts residents from neighboring communities.
Furthermore, public spaces such as
parks and trails are great assets that
contributes to the overall health of the
community.
Sixteen community members participated in the Manhattan, Churchill, and
Amsterdam study circles. The attendees of these sessions included representation from Manhattan emergency
response, civic organizations, faith
institutions, the school system, and
members of the senior community.
The majority of the study circle attendees were from Manhattan. While some
of the information gathered can be applied to the Churchill and Amsterdam
communities, the information in this
section may not be a true reflection of
those communities due to the lack of
representation in the study circles.
DEMOGRAPHICS
• Clean water
Based on the 2010 census, the population of Manhattan was 1,520, Churchill
was 902 and Amsterdam had a population of 180 which makes a combined
total of the area 2,602. According to
the census, 30% of the population of
Manhattan is living below 200% of
the Federal Poverty Level, which contrasts to 19% in Churchill and 6% in
Amsterdam.
• Community events
assets
The following is a list of assets that exist in the communities of Manhattan,
Churchill and Amsterdam.
• Agriculture
• Environment
• Farmers market
• Parks
• Parks and trails
• School field trips and activities
• Sports and recreation
• Support for neighbors and friends
• Volunteers
• School field trips and activities
24
•
Manhattan, churchill, & Amsterdam themes AND STRENGTHS
“This is where Idaho gets
its potatoes!”
• Youth activities*: A high population of latch-key
kids and a lack of productive youth activities contribute
to high-risk behavior.
• Access to healthcare resources*: A dentist is
the only healthcare provider that serves in Manhattan.
Services such as a clinic & pharmacy, mental health counseling, and emergency care are unavailable in Manhattan.
• Increase economic vitality*: Blackhawk is opening a factory in Manhattan, which will increase employment opportunities and demands for services within the
community. More businesses, such as entertainment facilities and a gym would improve health and quality of
life.
• Access to transportation: The community’s distance to services is not far enough to demand services
within the community, but is too far for easy access. Gas
prices into neighboring communities are a barrier to
needed services and activities.
• Mental health access: In the event of a mental
health emergency, a law enforcement officer must take
the individual to Bozeman to receive help, leaving fewer
officers in case of emergency. Mental health crises could
be prevented if awareness and out-patient care were
increased.
“For a community this size, I wouldn’t expect
the number of calls about suicide and violence
related to mental health.”
•
25
Manhattan, Churchill,
& Amsterdam
Manhattan Public Health System
community of Manhattan.
Manhattan
Family Dental
& Dr. Blanchet
Rotary Club
Volunteers
Town Council
EMT
Volunteer
Firefighters
Manhattan
Chamber of
Commerce
Manhattan
School System
MANHATTAN
COMMUNITY
Entrepreneurs
Neighbors
Manhattan
Police
Senior Center
Park Haven
Retirement Home
Manhattan
Christian
School
Faith Institutions
in Manhattan
Local
Farmers
MANHATTAN Action Ideas
• Create recreation programs during the
summer and after school: A survey was distributed to youth in Manhattan asking what activities are
most demanded and how much assistance youth are willing to contribute. The results of this survey will be used to
inform and explore recreation programs during the summer and after school.
26
•
• Connect with major employers, including
Blackhawk, to engage them in the community:
Create partnerships between the community and major
employers. Manhattan will benefit if employers see the
community as more than a location for their business.
THREE FORKS
community profile
Methodology
Three Forks is located in the western
region of the Gallatin Valley, about
30 miles west of Bozeman. The city
lies geographically near the point
in Missouri Headwaters State Park,
where the Jefferson, Madison, and
Gallatin Rivers converge to form the
Missouri River. Area attractions such
as Lewis and Clark Caverns State Park
and the newly renovated Sacajawea
Hotel have made Three Forks and the
surrounding area a regional hub for
tourism.
Three Forks has many strengths
and assets which promote healthy
lifestyles. An abundance of activities,
from a golf range to trails and civic
groups all help build a strong sense
of community pride. The small town
boasts an array of health services, including a clinic & pharmacy, chiropractor, and dentist, as well as an expanding school system and library and an
active ministerial and church collaboration. Residents do not have to travel
far for many of their needs.
Study circles in Three Forks occurred
over 4 sessions during March. Fifteen
Three Forks residents participated,
including representation from medical providers, town council representation, civic organizations, faith
institutions, members of the senior
community and representation from
the school system.
DEMOGRAPHICS
• Security
Based on the 2010 census, the population of Three Forks was 1,869, of
which 16% were over the age of 65.
According to the census, 40% of the
population of Three Forks is living below 200% of the Federal Poverty Level,
which is the highest in the county.
• Senior Center
assets
The following is a list of assets that exist in Three Forks.
• Access to Healthcare
• Community events
• Community Pride
• Faith Community
• Golf Course
• Library
• Museums
• Parks and Recreation
• Quilting and Civic Clubs
• Tourism and Sacajawea Hotel
• Trails
• Volunteers
“People know where Three
Forks is... we can use that to
our advantage.”
Three forks themes AND STRENGTHS
•
27
THREE FORKS
areas that the participants believed would have a substantial and lasting impact on the health of Three Forks.
• Maintaining the services already available*: Three Forks has a lot of health services available
within the community, but the lack of a retention plan
challenges the long term sustainability of services. If key
players leave, Three Forks could be left without health
services.
• Communication*: Communication about events
and services in Three Forks is important for building
and maintaining available services. Communication
about services is also important between service providers and concerned residents so people can be referred.
Communication between families is also lacking, as family
dynamics change and families spend less time together.
• Food security: Food security is uncertain for vulnerable groups including youth and the very elderly. Many
youth show up to the youth center without having eaten,
and the very elderly rely on their neighbors for food.
28
•
• Youth*: Many youth in Three Forks are without adult
supervision and without after-school activities, which
contributes to drug and alcohol abuse and high teenage pregnancy rates. A youth recreation center is serving
many at-risk youth, but has limited hours. In order to remain open, the owners are currently seeking a permanent
location where they may be able to increase services.
• Mental health access: Three Forks does not have
any mental health services.
“I didn’t know that was going on! How can services
remain here if we don’t know they’re here?”
THREE FORKS Public Health System
community of Three Forks.
Three Rivers
Medical Clinic
Volunteers
Sacajawea
Hotel
Youth Rec
Center
EMT
Volunteer
Firefighters
Town Council
Chiropractic Clinic
of Three Forks
Ministerial
Association
Three Forks
Chamber of
Commerce
Three Forks
School System
THREE FORKS
COMMUNITY
Neighbors
Senior Center
Pathways
Assisted
Living, Inc.
Faith Institutions
in Three Forks
Headwaters
Rehabilitation
Gallatin Valley
Food Bank
Three Forks
Police
Library
Three forks action ideas
• Increase communication: Formulate newsletters
or community gatherings so people know what’s going
on and what services are available.
• Enhance youth center: Find a permanent location for the youth center and transportation to and from
the location.
•
29
WEST
yellowstone
community profile
Methodology
West Yellowstone is located in
southern Gallatin County, adjacent to Yellowstone National Park.
Surrounded on the remaining sides
by the Gallatin National Forest, West
Yellowstone is a hub for tourism and
outdoor recreation. It is 90 miles south
of Bozeman and 100 miles north of
Idaho Falls, Idaho, which can be very
isolating and challenging for residents, especially regarding access to
services.
West Yellowstone has many
strengths and assets which promote
healthy lifestyles. Outdoor recreation is easily accessible throughout
the town and parks surrounding it.
Numerous trails provide healthy recreation to residents throughout the winter and summer months. Furthermore,
the small town boasts an array of services, including a clinic & pharmacy,
counseling, dentist, physical therapist,
and chiropractor.
Eighteen West Yellowstone residents
participated in the study circles, which
occurred over three sessions in May.
The attendees of these sessions included representation from medical
providers, the town council, civic organizations, faith institutions, and members of the senior community.
DEMOGRAPHICS
Based on the 2010 census, the population of West Yellowstone was 1,271, of
which 17.9% were Hispanic or Latino.
According to the census, 35% of the
population of West Yellowstone is living below 200% of the Federal Poverty
Level.
assets
The following is a list of assets that
exist in the community of West
Yellowstone.
• Education
• Access to healthcare
• Volunteers
• Trails
• Museums
• Yellowstone National Park
• Natural environment
• Mental health services
• Tenacity of residents
• Tourism
• Diversity
“West is unique... there’s something about it that makes
you want to stay.”
30
•
West yellowstone themes AND STRENGTHS
areas that the participants believed would have a substantial and lasting impact on the health of West Yellowstone.
• Community Integration and networking: In
order to find information about events in the community,
you have to be looking for it. Increasing community participation could increase emotional commitment to the
community so that people are invested. West has one of
the highest Hispanic populations within the county, yet
integration is difficult because of language barriers.
• Seasonal economy: The economy in West
Yellowstone relies on the tourism from Yellowstone
National Park. Employment opportunities are highly seasonal, and there are few long-term careers available for
residents. Many residents are seasonal, and the influx of
summer tourists also brings transient populations.
• Affordable housing: Quality and affordable housing is lacking in West Yellowstone. Many housing arrangements are organized by employers, but this is seasonal. Affordable housing is a cyclical issue: if there’s not
enough housing, businesses can’t hire, and if no one will
hire, there won’t be housing.
• Crisis healthcare*: In case of challenges with mental health, victims of sexual assault or partner/family
member assault there are no options for care. Since the
recent introduction of mental health counseling through
the Gallatin Mental Health Center, there have been fewer
mental health crises in the community.
• Access to and knowledge of various forms
of healthcare: Vulnerable groups, including the
transient and Hispanic populations are largely unaware
of quality and affordable healthcare options and services
that are available in West Yellowstone.
• Alcohol and drug counseling and rehabilitation: West Yellowstone faces challenges with
substance abuse in the community, especially among the
transient populations. There are limited alcohol rehabilitation options within the community, and no options for
low-income individuals.
“When Yellowstone Park coughs,
we catch a cold.”
•
31
WEST
yellowstone
WEST YELLOWSTONE Public Health System
community of West Yellowstone.
Fire Department
Lone Peak
Physical Therapy
Community
Health Partners
City Council
Volunteers
West Yellowstone
Chamber of Commerce
West Yellowstone
School System
Povah
Community
Center
WEST YELLOWSTONE
COMMUNITY
Local Employers
EMT
West Yellowstone
Dental
Neighbors
Senior Center
West Yellowstone
Social Services
West Yellowstone
Back & Neck
West Yellowstone
Police
West Yellowstone
News
Community
West Outreach
Yellowstone
National Park
WEST YELLOWSTONE Action Ideas
• Increase access to crisis healthcare and
crisis counseling: Community Health Partners
hosts counseling services from Gallatin Mental Health
Center, which is well utilized. Increasing counseling options, as well as implementing a peer-to-peer hotline or
crisis line for crisis counseling could address more acute
mental health crises.
• Encourage employer drug and alcohol
testing: Community West Outreach is encouraging
employer drug and alcohol testing among new hires.
32
•
Through this initiative, Community West Outreach
minimizes costs to employers by providing the needed
documents and provides resources for substance abuse
education. With more people involved, reaching out to
employers would be faster.
• Community gathering: A community gathering
would increase community cohesiveness. Celebrating
together with an international food festival or dance contest would integrate different populations and could help
communication efforts throughout the community.
Local Public Health
System Assessment
the local Public Health System
What defines a public health system? In Gallatin County, the local public health system is comprised of many organizations
(public, private and voluntary entities) and individuals that engage in activities that contribute to the delivery of the ten
essential public health services. It takes more than healthcare providers and public health agencies to address the social,
economic, environmental and individual factors which influence health.
Faith Institutions
Healthcare
Providers
Civic Groups
Transit
Employers
Law Enforcement
EMS
Parks and Rec
Dentists
Elected
Officials
Mental Health
Tribal Health
YOU!
Fire
Labs
Drug Treatment
Non-Profits
Corrections
Public Health
City Planners
Home Health
Neighborhood
Organizations
Schools
Nursing Homes
This assessment will assist in identifying paths for improvement, ensuring the provision of quality services, and the means
for implementing more efficient responses to public health challenges.
The Local Public Health System Assessment helps to answer the questions:
What are the activities and capacities of our public health system?
How well are we providing the Essential Public Health Services in our county?
The Ten Essential Public Health Services:
1. Monitor health status to identify community health
problems
6. Enforce laws and regulations that protect health and
ensure safety
2. Diagnose and investigate health problems and health
hazards
7. Link people to needed personal health services and
assure the provision of health
3. Inform, educate, and empower people about health
issues
8. Assure a competent public and personal health care
workforce
4. Mobilize community partnerships to identify and solve
health problems
9. Evaluate effectiveness, accessibility, and quality of
personal and population health services
5. Develop policies and plans that support individual and
community health efforts
10. Research for new insights and innovative solutions to
health problems
Local public health system assessment
•
33
Local Public Health
System Assessment
Methodology
Gallatin County participated in The
National Public Health Performance
Standards Program (NPHPSP) Local
Assessment, which is framed around
tthe 10 Essential Public Health
Services (EPHS).This program is used
throughout the United States to evaluate the performance of local public
health systems. It was developed in
2001 as a collaboration of the Center
for Disease Control (CDC) and the
National Association of County and
City Officials (NACCHO).
Within the Local Instrument, each
EPHS includes between 2-4 model
standards that describe the key aspects of an optimally performing
public health system. Each model
standard is followed by assessment
questions that serve as measures of
performance. Each site’s responses to
these questions should indicate how
well the model standard - which portrays the highest level of performance
or “gold standard” - is being met.
Participants responded to assessment questions using the following response options below. These
same categories are used in this report to characterize levels of activity for Essential Services and model
standards.
LPHSA Performance Scoring Scale
Optimal Activity
Greater than 75% of the activity is met
Significant Activity
Greater than 50% but no more than 75% of the activity is met
Moderate Activity
Minimal Activity
No Activity
0% or absolutely no activity
PROCESS
Community Involvement
The assessment was conducted in two separate three-hour
meetings. Workgroups were organized by Essential Public
Health Service, and participants chose which services they
thought they best represented based on short summaries
of each. Each workgroup was professionally facilitated using an electronic voting system to streamline the voting
process. Scoring is based on the knowledge and perception of participants in each EPHS group. This perception
may not always be a true reflection of activity that is or is
not taking place in the county.
Because of the limitations noted, the results and recommendations associated with these reported data should
be used for quality improvement purposes and guiding an
overall public health infrastructure and performance improvement process.
This process is limited in that it only represents the organizations and people present at the meeting. Thirty-eight
organizations and sixty-five individuals participated, including representation from the local health department,
healthcare providers, human service organizations, schools
and universities, elected officials and governmental organizations, faith institutions, youth development organizations,
economic and philanthropic organizations, and environmental agencies.
34
•
SUMMARY OF FINDINGS
Summary of Essential Public Health Services Scores
EPHS1
Monitor health status to identify community health problems
30
EPHS2
Diagnose and investigate health problems and health hazards
68
EPHS3
Inform, educate, and empower people about health issues
52
EPHS4
Mobilize community partnerships to identify and solve health problems
29
EPHS5
Develop policies and plans that support individual and community health efforts
62
EPHS6
Enforce laws and regulations that protect health and ensure safety
62
EPHS7
Link people to needed personal health services and assure the provision of health
35
EPHS8
Assure a competent public and personal health care workforce
41
EPHS9
Evaluate effectiveness, accessibility, and quality of personal and population health services
51
EPHS10
Research for new insights and innovative solutions to health problems
55
OVERALL SCORE
Challenges
Based on the results from the assessment, the following areas have been
identified as top challenges to the local public health system.
Essential Service 4: Mobilize
community partnerships to Identify
and solve health problems
• The number of partnerships and
strategic alliances between organizations could be increased to help
maximize impact on the populations they serve.
Essential Service 1: Monitor
Health Status to Identify Community
Health Problems
• There is limited sharing and access
49
STRENGTHS
to assessments that are conducted
by organizations that would contribute to the understanding of health
statuses within the county.
• There is limited knowledge and access of population health registries.
Essential Service 7: Link people
to needed personal health services
and assure the provision of health
• There is a lack of coordination between organizations that provide
personal health and social services.
• There is a lack of Spanish-speaking
services- especially for mental
health counseling.
While there are many areas of opportunity to improve within the public
health system, there are also many areas in which Gallatin County is within
the area of ‘significant activity’. Those
specific areas that were ranked highest are listed below.
• Optimal planning and protocols for
public health emergencies
• Strong authority and enforcement
with regard to public health laws,
regulations and ordinances
• Linking higher learning and research
to the public health sector
•
35
Forces of Change
Assessment
The Forces of Change (FOC) assessment focuses on identifying the local, state and national forces such as legislation, technology, and other impending changes that affect the context in which the community and its public health system operate.
Methodology
The Forces of Change Assessment was conducted during
a single three-hour brainstorming session that was professionally facilitated. Thirteen public health professionals participated in the assessment, with representation from across
the county including academia, community health, rural
health, and environmental health organizations. Participants
were asked to identify factors, trends and events affecting
the health of Gallatin County, ranging from economic forces
to social, political, and environmental forces. After compiling a list of forces, participants were asked to identify both
threats and opportunities for many of the forces identified.
This list was sent out to MAPP committee members for
comments, suggestions, and additions. Once the list was
finalized, members of the MAPP Committee organized the
list into categories. The following is a summary of the assessment results.
THEME FORCES
• Tough economic climate / Recession
• Youth issues
• Changing demographics
• Health access and quality
• Changing political landscape
SUMMARY OF THE RESULTS
The Local Public Health System is not operating in a vacuum: there are many global, national and regional forces that affect
how our local system can operate. Overarching forces affecting our local public health system are the economic climate,
youth issues, changing demographics, access and quality of healthcare services, and the political landscape.
ECOnomic climate
The recession of 2009 and the ensuing period of slow economic growth
have had dramatic consequences.
Recovery has continued to be slow
and job growth is the slowest in history. Unemployed and underemployed
individuals have less access to health
insurance and must prioritize their
greatest needs. Tightening local,
state, and national budgets mean less
funding for research and development
36
•
forces of change assessment
as well as for programs funding important infrastructure development (such
as water and sewer) that directly impact community and individual health.
Locally, Gallatin County has seen
the impact of the struggling economy
as an increasing number of individuals
look to the local public health system
for support. Residents are seeking
services and amenities more locally to
avoid high gas prices. Uninsured and
underinsured individuals, with high
deductibles have difficulty paying
for preventive health services, dental care, and mental health services.
In a tough economic climate, mental
health services are especially important, but a stigma against it as well as
decreased time and money to seek
out mental health services make help
less accessible.
The unpredictability of the tourism industry, on which many communities across Gallatin County depend,
causes a stressful seasonal economy,
especially among a tough national
and global economy. Since tourism
revolves around the outdoor activities
and environment, environmental patterns, such as severe weather, affect
the tourism and the economy in the
county.
YOUTH EMPOWERMENT
Across the country, the struggling
economy has decreased the ability of
youth to find productive employment
and the accessibility of services and
activities for youth. There is not lack
of activities for kids and youth, but in
rural communities, the time and resource commitment to transport kids
to population centers is limiting. Due
to limited meaningful engagement,
many youth and adolescents are left
without purpose and may lean towards risky behaviors out of boredom.
Family dynamics across the country
are changing as families are struggling
to make ends meet.
In Gallatin County, many parents
in need of employment have begun
work at the Bakken oil fields, leaving
children and youth alone. With decreased supervision and limited youth
activities, Gallatin County is experiencing youth substance abuse and
teen pregnancy.
Changing demographics
The US population is expected to
increase around 100 million, as well
as grow somewhat older by 2050.
America’s relatively high fertility rate
is thanks larger to recent immigrants
who tend to have more children than
residents who have been in the US
for several generations. Population
growth causes more demands on infrastructure, especially in rural areas,
and services such as affordable housing and education. As baby boomers
retire, the population is aging, which
is increasing demands on social security and on end of life healthcare
infrastructure.
The population of Gallatin County
has increased 32% since 2000, according to the US Census. Much of
the population growth is occurring
in rural areas, without the water and
sewage infrastructure to maintain the
increase in population. Across the
county, affordable housing is lacking.
Although education is more available, with Gallatin College, a 2-year
program, and online courses, decreased education funding threatens
public education. Furthermore, an
increasing migrant population and
Veterans returning to Gallatin County
with Post-Traumatic Stress Disorder
require adapting outreach strategies
and services.
ACCESS & QUALITY
The global pattern of disease burden is shifting from communicable
diseases to chronic diseases, making
prevention, focus on holistic care, and
public health education more important. The Affordable Care Act aims to
increase access to and affordability of
health services.
Locally, a high number of uninsured and underinsured people forces
funding to go toward treatment instead of prevention, which is more
expensive. Furthermore, this creates
disparities in health access and quality of care, especially for people below 200% of the federal poverty level.
Increased accessibility and affordability and changing regulations due to
the Affordable Care Act will increase
demands on the Local Public Health
System. Accessibility and quality of
health services is changing locally, as
well, shifting toward a patient centered care model and electronic health
records. The lack of a local detox center increases the burden and difficulty
of seeking treatment for an addiction
and contributes to high rates of substance abuse throughout the county.
changing political
landscape
The political landscape is shifting nationally and locally which threatens
funding for public health. Nationally,
the November 2012 presidential election will potentially change funding
and regulations for public health initiatives across the country as well as
change access and quality of healthcare services. The polarization of political parties has made certain areas
of public health more controversial.
Distrust of the government
throughout the state, as well as a federal deficit, has caused a shift toward
nonprofit service providers instead of
government. The reconvening of the
MT legislature, which has switched to
a Republican majority for the first time
since 2003, as well as a new governor
in January, will change public health
funding locally.
forces of change assessment
•
37
Community Health
Status Assessment
2011 PRC Community Health Survey
methodology
sample approach & Design
This assessment incorporates data from primary research
(the 2011 PRC Community Health Survey)3 and secondary research (vital statistics and other existing health-related data).
It also allows for comparison to benchmark data at the state
and national levels. The scope of the PRC assessment covered Park, Madison and Gallatin Counties to correspond with
the service areas of Bozeman Deaconess Health Services (all
three counties) and Community Health Partners (Gallatin and
Park counties). For the purposes of the Community Health
Status Assessment, Gallatin County data was isolated from
the other two counties.
A precise and carefully executed methodology is critical in
asserting the validity of the results gathered in the 2011 PRC
Community Health Survey. Thus, to ensure the best representation of the population surveyed, a telephone interview
methodology was employed. The primary advantages of telephone interviewing are timeliness, efficiency and random-selection capabilities.
The sample design used for this effort consisted of a
stratified random sample of 400 individuals age 18 and older
in Gallatin County. The sample was stratified to include 200
interviews in Bozeman and 200 in Other Gallatin County; after
the data were collected, the interviews were weighted in proportion to the actual population distribution of these areas so
that overall findings properly reflect the Total Area as a whole.
Conducting 200 surveys in Other Gallatin County was limiting in that it was more difficult to get statistically significant
data in the smaller communities located within the county.
Similarly, the racial and ethnic populations in Gallatin County
are small enough that gathering data on health outcomes and
trends was challenging. Within this report, the sub-population
that you will see most frequently highlighted is people living
below 200% of the Federal Poverty Level (FPL).
Survey instrument
The survey instrument used for this study is based largely on the
Centers for Disease Control and Prevention (CDC), Behavioral
Risk Factor Surveillance System (BRFSS), as well as various other public health surveys and customized questions addressing
gaps in indicator data relative to health promotion and disease
prevention objectives and other recognized health issues. The
final survey instrument was developed by Bozeman Deaconess
Health Services, Community Health Partners (CHP), and the
Gallatin City-County Health Department, in conjunction with
Professional Research Consultants (PRC).
Community Health Status Assessment Indicators
Following the extensive 2011 PRC
Community Health Survey, the MAPP
Committee selected indicators which
represented Gallatin County’s health
status. These indicators were chosen
after consideration of indicators used
in the 2012 County Health Rankings,
Healthy People 2020 and the National
Prevention Strategy to ensure that
the indicators and measures selected were comparable to state and
national benchmarks. Social and
3
environmental determinants of health
were also considered when selecting
indicators. Furthermore, since the information is meant to be tracked over
time, it was important that the data be
available in future years.
Many of the indicators that were
chosen come from the PRC assessment that was conducted in 2011. The
additional indicators were selected in
order to give a comprehensive snapshot of health in Gallatin County. Other
For the full PRC report, please visit http://bozemanregion.healthforecast.net/
38
•
community health status assessment
indicators were chosen from available
data from sources that included:
• CDC
• Montana Vital Statistics
• County Health Rankings
• Montana Department of Health and
Human Services.
Indicators were benchmarked against
Healthy People 2020 and the National
Prevention Strategy, where applicable.
indicator
meas u re
so u rce
Social, economic, and environmental factors
Social and economic factors
Education
% of high school graduates (includes equivalency)
2006-2010 ACS, County Health Rankings
Employment
Unemployment Rate
% Victim of a violent crime in the past 5 years
Domestic Violence Rates
% Individuals below 200% of the Federal Poverty Level
2006-2010 ACS, County Health Rankings
PRC 2011, County Health Rankings
PRC 2011
2006-2010 ACS
Community Safety
Income
Environmental factors
Built environment
% ZIP Codes with Healthy Food Outlets
% Have Access to Public Exercise Facilities in Neighborhood
environmental
quality
# of days w/ PM 2.5 levels over National Standard
CDC PHASE, County Health Rankings
BEHAVIORS, STRESS, AND PHYSICAL CONDITION
BEHAVIORS
SEXUAL HEALTH
INJURY & VIOLENCE
PREVENTION
SUBSTANCE ABUSE
Diet and Exercise
Tobacco Use
Pregnancy Rates among Adolescent Females aged 15-19 / 1,000
% [Age 18-64] Tested for HIV in the past year
Chlamydia Incidence per 100,000
% “Always” Wear Seat Belt
% [Homes With Firearms] Weapon(s) Unlocked & Loaded
% Binge Drinker (Single Occasion- 5+ drinks Men, 4+ drinks Women)
% Obese
% of adults who meet physical activity recommendations
% Current Smoker
% Use Smokeless Tobacco
MT DPHHS 2009, National Prevention Strategy
PRC, 2011; HP 2020
MT DPHHS, CDC
PRC 2011, HP 2020
PRC 2011
PRC, 2011, National Prevention Strategy, HP 2020
PRC, 2011, National Prevention Strategy, County
Health Rankings, HP2020
PRC 2011, National Prevention Strategy, HP 2020
PRC, 2011, National Prevention Strategy, County
Health Rankings, HP 2020
PRC, 2011
Clinical Care & Access
Immunizations
Insurance and Access
Prenatal Care
Dental Care
Cancer Screenings
Blood Pressure
Screening
Blood Cholesterol
Testing
% [19-35 mos] who received recommended doses of DTaP, Polio, MMR,
HIb, hepatitis B, varicella, and PCV vaccines
Pertussis per 100,000
% [Age 18-64] Lack health insurance
% difficulty Accessing Healthcare in the past year (composite)
% Have Dental Insurance
% Received Prenatal Care in First Trimester
% [Age 18+] Dental Visit in Past Year
%[Age 50-75] Colorectal Cancer Screening
% [women 50-74] Mammogram in Past 2 years
% women [21-65] Pap Smear in past 3 years
HP 2020, DPHHS
PRC, 2011, MT DPHHS
PRC 2011, County Health Rankings, HP 2020
PRC, 2011
PRC, 2011
PRC, 2011, National Prevention Strategy
PRC, 2011, HP 2020
PRC, 2011, National Prevention Strategy
PRC 2011
% Blood Pressure Checked in Past 2 years
PRC, 2011
% adults blood cholesterol screening
PRC, 2011
% Major Depression
PRC 2011, National Prevention Strategy
stress
mental health
HEALTH OUTCOMES
DEATHS (MORTALITY)
Cancer (age-adjusted Death Rate)
Diabetes Melitus (Age-Adjusted Death Rate)
Diseases of the Heart (Age-Adjusted Death Rate)
Unintentional Injury (Age-Adjusted Death Rate)
Motor Vehicle Crashes (Age-Adjusted Death Rate)
Firearm-Related Deaths (Age-Adjusted Death Rate)
Suicide (Age-Adjusted Death Rate)
PRC, 2011, HP 2020, National Prevention Strategy
Infant Mortality Rate
PRC 2011, National Prevention Strategy
Quality of Life
% “Fair/Poor” Physical Health
Low Birth weight
% of Low Birth weight Births
PRC 2011
PRC, 2011, National Prevention Strategy, HP2020,
County Health Rankings
CHRonic disease
INJURY & VIOLENCE
Suicide
Maternal & Child
Health
PRC, 2011, HP2020
PRC 2011, HP2020
PRC 2011, HP2020, National Prev Strategy
PRC 2011, HP2020
PRC 2011, HP2020
PRC 2011, HP 2020
Illness (Morbidity)
community health status assessment
•
39
Demographic Profile
of Gallatin County
The size, age and gender composition of the population are important determinants of healthcare needs of a community.
The population pyramid illustrates the age and sex distribution of Gallatin County.
AGE distribution Gallatin County, 2010
UNDER 5 YEARS
• The male to female population in
Gallatin County is almost equal, with
slightly more males (51.9%) than
females (48.1%).
• The Median age in Gallatin County is
32.5, males- 31.8 and females- 33.4.
5 TO 9 YEARS
10 TO 14 YEARS
• The 20-24 year old age group
makes up the largest percentage
of all groups in Gallatin County,
representing 11.7% of the population.
15 TO 19 YEARS
20 TO 24 YEARS
25 TO 29 YEARS
30 TO 34 YEARS
35 TO 39 YEARS
40 TO 44 YEARS
MALE
FEMALE
45 TO 49 YEARS
50 TO 54 YEARS
• Exactly 25% of the population in
Gallatin County is under the age of
19.
• 9.4% of the population in Gallatin
County is over the age of 65.
55 TO 59 YEARS
• Gallatin County’s population has
increased 32% since 2000.
60 TO 64 YEARS
65 TO 69 YEARS
• Gallatin County is the fastest
growing county in Montana.
70 TO 74 YEARS
75 TO 79 YEARS
• In 2003, the population of Gallatin
County was expected to increase
to 116,000 by 2030.
80 TO 84 YEARS
85 YEARS +
0%
40
•
5%
demographic profile of gallatin county
10%
15%
Source: US Census Bureau, 2010
MT Planning Commission, 2003
healthcare resources
COMMUNITY ASSETS
GALLATIN
Health care facilities
Local Hospital
1
CAH (Critical Access Hospital)
Total # of Beds
Rural Health Clinics
Community Health Centers
PRIMARY CARE PROVIDER
Doctors (MDs and DOs)
Nurse Midwives (NMW)
Nurse Practitioners (NP)
Physician Assistants (PA-C)
DENTAL PROVIDERS
Dentists
Dental Hygienists
AGING SERVICES
Nursing Homes
Assisted Living Facilities
Adult Foster Care
Adult Day Care Licenses
0
86
2
3
population by racial
demographic
• The minority (non-white) population in Gallatin County
makes up 4.6% of the entire population.
• Persons of Hispanic or Latino origin are the largest
minority with 2.9% of Gallatin County’s population.
1% 1.7%
1.9%
116
1
52
39
64
60
3 (283 beds)
13 (367 beds)
3
2
95.4%
Source: 2009 Montana County Health Profiles, Montana DPHHS
WHITE
OTHER*
AMERICAN INDIAN & ALASKA NATIVE
PERSONS REPORTING TWO OR MORE RACES
* Includes Black and Asian/ Pacific Islander, racial categories
include people of Hispanic and non-Hispanic ancestry
demographic profile of gallatin county
•
41
Social and
Economic Factors
education
100%
96% of people 25 years and over in
Gallatin County have at least graduated from high school (or the equivalent). Four percent had left school
before graduating from high school.
This compares to 91% high school
graduation in Montana, and 85.6% in
the United States.
People with more education are
likely to live longer, to experience 50%
better health outcomes, and to practice health-promoting behaviors such
as exercising regularly, refraining
from smoking, and obtaining timely
health care check-ups and screenings.
Educational attainment among adults
is linked with children’s health as well.
People who are unemployed are less
likely to have health insurance and are
more likely to be below the poverty
level.
Sourde: U.S. Bureau of Labor Statistics, Local
Area Unemployment Statistics, 2011
28.9%
17.6%
7.9%
6.3%
7.5%
0%
28.5%
Some college,
no degree
9th to 12th
grade, no diploma
Less than
9th grade
100%
80%
31.2%
60%
8.5%
3.0%
1.0%
Montana
5.0%
US
Average Unemployment
Rate 2011
10
9
8
7
6
5
4
3
2
1
0
Associate’s degree
(includes equivalency)
% of High School Graduates
(or the equivalent), population 25 Years and Older
23.6%
Gallatin
County
Bachelor’s degree
High school
graduate
21.4%
24.0%
6.1%
Employment
Unemployment rate
Graduate or
professional degree
19.2%
3.0%
KEY
10.3%
21.0%
– Robert Wood Johnson Foundation, Commission
to Build a Healthier America, “Education Matters
for Health”
Source: U.S. Census Bureau,
2006-2010 American Community Survey.
8.6%
16.1%
96.0%
91.0%
85.6%
Gallatin
County
Montana
US
40%
20%
0%
industries
(Most common in Gallatin County)
• Construction 13%
• Retail Trade 12.7%
• Education, health care and social
assistance 20.5%
6.1%
6.8%
8.9%
Gallatin
County
Montana
US
• Arts, recreation, and
accommodation 12.2%
74.5% of the people employed were
private wage and salary workers;
15.9% were federal, state, or local
government workers; and 9.5% are
self-employed.
Source: U.S. Census Bureau, 2006-2010
42
•
income
household income
• Northwest Indicators
ranks Gallatin County
5th highest of all 56
counties in the state of
Montana for household
income.
• The median household
income for 2010 in
Gallatin County was
$50,136 and per capita
income was $20,423.
% of individuals below 200%
of the Federal Poverty Level
$200,000 or more
$150,000 to $199,999
36%
$100,000 to $149,999
34%
$75,000 to $99,999
32%
$50,000 to $74,999
30%
$35,000 to $49,999
28%
$25,000 to $34,999
30.2%
35.0%
32.0%
Gallatin
County
Montana
US
26%
$15,000 to $24,999
$10,000 to $14,999
Source: U.S. Census Bureau,
2006-2010 American Community Survey.
Less than $10,000
0
2,000 4,000 6,000 8,000
TOTAL HOUSEHOLDS
community safety
People are healthiest when they feel safe, supported and connected and can trust others in their families, neighborhoods,
workplaces, and communities.
% Victim of violent crime in the past 5 years
Estimates of violent victimization include rape or sexual
assault, robbery, aggravated assault, and simple assault.
The rate of violent crime victimizations declined by 13% in
the United States in 2010.
5%
4%
3%
2%
1%
0%
0.9%
2.5%
1.4%
1.5%
Bozeman
Gallatin
County
Montana
US
Domestic Violence Rates, 2007-2009 Annual
Average Offenses per 100,000 Population
7.4% of Gallatin County
respondents report being hit, slapped, pushed,
kicked, or hurt in any way
by an intimate partner; this
compares with 13.5% in
the United States. Gallatin
County’s rates of domestic
violence — 283.4 offenses
per 100,000 population in
the 2007-2009 annual average — are notably lower
than Park County’s, at 551.2.
500
400
300
200
283.4
433.5
Gallatin
County
Montana
100
0
Source: Professional Research
Consultants, Inc. PRC Community
Health Survey.
Sources: The National Crime Victimization Survey, 2010. http://bjs.ojp.
usdoj.gov/index.cfm?ty=pbdetail&iid=2224
Professional Research Consultants, Inc. PRC Community Health Survey.
•
43
environmental
factors
Built Environment
% Zip Codes with Healthy Food Outlets, 2008
100%
80%
60%
40%
86%
41%
Gallatin
County
Montana
20%
0%
84.3% of Gallatin County
residents feel it is easy to
purchase healthy foods in
the neighborhood. Adults
less likely to feel it is easy
to purchase healthy foods
in the neighborhood are
those under age 40 and
lower-income residents.
% Have Access to Public Exercise Facilities in
Neighborhood
One-half of Gallatin County Residents report having access
to public exercise facilities in their own neighborhoods.
“Public exercise facilities” were described to respondents
as facilities that were generally free or low-cost and may
include things like walking or running tracks, basketball or
tennis courts, swimming pools, sports fields, and so on.
100%
80%
60%
40%
20%
Source: County Health Rankings. University of Wisconsin Population
Health Institute & Robert Wood Johnson Foundation. www.countyhealthrankings.org
Percentages represent 2008 data.
In this case, the term “healthy food outlets” includes grocery stores with >4 employees, and produce stands or farmers’ markets.
0%
57.4%
38.3%
50.9%
36.1%
Bozeman
Other
Gallatin
Gallatin
County
Below 200%
poverty,
Gallatin County
Source: Professional Research Consultants, Inc. PRC Community Health
Survey. [Item 110]
Asked of all respondents
Public exercise facilities include free or low-cost “parks and recreation” facilities,
YMCA, or a local community center.
environmental quality
The indicator for air quality is Particulate Matter levels over 2.5 microns. This measurement
indicates fine particles or droplets in the air that are less than 2.5 microns wide, or about 30
times smaller than human hair. Outside, they come primarily from motor vehicle exhausts,
power plants, wild fires, manufacturing processes, and the reaction of gases in the atmosphere. Indoor sources include tobacco smoke, cooking, fireplaces, and candles.
Source: Centers for Disease Control and Prevention. National Environmental Public Health Tracking Network.
(n.d.) Web. www.cdc.gov/ephtracking.
County Health Rankings Summary Information- Montana
44
•
environmental factors
# of Days with PM 2.5
levels over National
Standard (2006)
10
8
6
4
2
0
Gallatin
County
Montana
behaviors
sexual health
Pregnancy Rates among Adolescent Females
aged 15-19
Adolescent pregnancy and childbearing have been associated with adverse health and social consequences for
young women and their children.
100%
80%
% Age 18-64 Tested for HIV in the Past Year
By demographic characteristics, the following population segments (aged 18-44)
are more likely to have been
tested in the past year
• Lower-Income Adults
• Non-Whites
20%
Healthy People 2020
80%
Target=16.9% or Higher
60%
40%
0%
26.1% 25.0%
47.8% 48.8%
Gallatin County
Montana
Chlamydia Incidence per 100,000
100%
20%
2007-2009
40%
0%
Sources: http://www.dphhs.mt.gov/publichealth/wmh/documents/teenpregnancyratesinmontanabycounty.pdf
2004-2006
60%
16.3%
19.9%
Gallatin
County
US
Sources: Professional Research Consultants, Inc. PRC Community Health
Survey. [Item 178]
Professional Research Consultants. PRC National Health Survey. 2011.
US Department of Health and Human Services. Healthy People 2020.
December 2010 http://healthypeople.gov. [Objective HIV-14.1]
Note that the Healthy People 2020 objective is for those aged 15 through 44.
500
Almost half of the
estimated 19 mil400
lion new STD in300
fections each year
200
are among young
289.4
305.6
391.6
100
people ages 15-24.
Because many STDs
0
go undiagnosed, reGallatin Montana
US
County
ported cases represent only a fraction
of the true burden of STDs in the US. Untreated STDs can lead
to serious long-term consequences, including infertility. Rates
of Chlamydia have increased in recent years across Montana
and the United States.
Sources: Montana Department of Public Health and Human Services
Communicable Disease Program
Centers for Disease Control and Prevention, Epidemiology Program
Office, Division of Public Health Surveillance and Informatics.
behaviors
•
45
behaviors
Injury and Violence Prevention
Injuries are the leading cause of death for Americans ages 1 to 44, and a leading cause of disability for all ages, regardless
of sex, race/ethnicity, or socioeconomic status.
% “Always” Wear
a Seat Belt
Motor vehicle accidents
accounted for 57.7% of accidental deaths throughout
Gallatin, Madison, and Park
Counties between 2005
and 2007. Men and whites
are less likely to report consistent seat belt usage.
100%
Healthy People 2020
80%
60%
40%
79.8%
85.3%
20%
0%
% [Homes with Firearms] Weapons(s)
Unlocked & Loaded
Between 1999 and 2007, there was an annual average ageadjusted firearm-related mortality rate of 13.4 deaths per
100,000 population in Gallatin County; this is higher than
the Healthy People 2020 objective of 9.2.
100%
Gallatin
County
US
Survey.
December 2010 http://www.healhtypeople.cov. [objective IPV-15]
80%
60%
40%
20%
0%
11.2%
22.3%
15.1%
16.9%
Bozeman
Other
Gallatin County
Gallatin
County
US
Survey. [Item 167]
Substance Abuse
The effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public health
problems including teenage pregnancy, sexually transmitted diseases, domestic violence, motor vehicle crashes, and crime.
% Binge Drinker (single occasion- 5+Drinks Men, 4+ Drinks Women)
Binge drinking is more prevalent among men and adults
under age 40.
100%
80%
Healthy People 2020 Target=24.3% or Lower
60%
Sources: Processional Research Consultants, Inc. PRC Community Health
Survey. [Item 202]
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor
Surveillance System Survey. Atlanta, Georgia: US Department of Health
and Human Services, Centers for Disease Control and Prevention, 2010
Montana Data.
46
•
behaviors
40%
20%
0%
23.3%
15.5%
20.7%
17.0%
Bozeman
Other
Gallatin County
Gallatin
County
US
diet and exercise
The goal of promoting healthful diets and healthy weight encompasses increasing household food security and eliminating hunger. Diet and body weight are related to health status as it is important to growth and development of children and
helps Americans reduce their risks for many health conditions. It is one of the most prominent contributors to mortality,
contributing to 400,000 premature deaths.
% obese
100%
80%
• “Obese” includes respondents with
a BMI value ≥30.
60%
• Adults more likely to be obese
include the following populations
20%
»» Adults aged 40 and older
Healthy People 2020 Target=30.6% or Lower
40%
0%
9.5%
Bozeman
»» Whites
• There was no significant difference
between Gallatin County and those
below 200% of the FPL.
17.0%
12.0%
Other
Gallatin County
Gallatin County
23.5%
28.5%
Montana
US
Sources: Professional Research Consultants, Inc. PRC Community Health Survey. [Item 191]
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.
healthypeople.gov. [Objective NWS-9]
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey.
Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and
Prevention, 2009 Montana Data
% of Adults who meet physical activity recommendations
• Regular physical activity can improve
the health and quality of life of
Americans of all ages, regardless of
the presence of chronic disease or
disability.
100%
• Adults (age 18-64) should do 2 hours
and 30 minutes a week of moderateintensity or 1 hour and 15 minutes
(75 minutes) a week of vigorous
intensity aerobic physical activity,
or an equivalent combination of
moderate-and vigorous-intensity
aerobic physical activity.
20%
80%
Healthy People 2020 Target=47.9%
60%
40%
0%
58.7%
Bozeman
58.0%
58.5%
Other
Gallatin County
Gallatin County
58.6%
42.7%
Montana
US
Sources: Professional Research Consultants, Inc. PRC Community Health Survey [Item 183]
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey.
Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and
Prevention, 2009 Montana Data
• Those less likely to meet physical
activity requirements include men
and white respondents.
behaviors
•
47
behaviors
tobacco use
Tobacco is the most prominent contributor to mortality in the United States in 2000, contributing to an estimated 435,000.
Current Smokers
100%
• The percentage of current smokers
is much higher outside the
Bozeman community.
• There is no statistical difference
when viewed by demographic
characteristics
• 3.1% of Gallatin County residents
have a household member who
smokes in the home.
• There was no significant difference
between all Gallatin County
residents and those 200% below
the federal poverty level.
80%
Healthy People 2020 Target=12% or Lower
SOMEDAYS
EVERYDAY
60%
40%
20%
0%
7.5%
13.7%
9.6%
18.8%
16.6%
Bozeman
Other
Gallatin County
Gallatin
County
Montana
US
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System
Survey. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease
Control and Prevention, 2009 Montana Data.
healthypeople.gov. [objective TU-1.1]
Use of Smokeless Tobacco
• Smokeless tobacco causes a
number of serious oral health
problems, including cancer of the
mouth and gums, periodontitis,
and tooth loss.
25%
20%
15%
10%
5%
9.5%
18.7%
2.8%
Gallatin
County
Below
200%
FPL, in
Gallatin County
US
0%
48
•
behaviors
• Gallatin County is much higher than
the national percentage and is far
from satisfying the Healthy People
2020 target of 0.3% or lower.
Sources: Professional Research Consultants,
Inc. PRC Community Health Survey. [Item 196]
US Department of Health and Human Services.
Healthy People 2020. December 2010 http://
www.healthypeople.gov. [objective TU-1.2]
Clinical Care
and Access
vaccinations
childhood vaccinations
Aggregated results from clinic reviews- proportion of children 24-35 months who have
received all age-appropriate
vaccines (4:3:1:3:3:1) by 24
months as recommended
by the Advisory Committee
on Immunization Practices
(ACIP) in 2008.
100%
Healthy People 2020
Target=90% or Higher
for all vaccines in series
80%
60%
40%
70%
63%
Gallatin
County
Montana
20%
0%
Sources: Montana Department of Health and Human Services Data for
Community Health Assessments, Communicable Disease item #1.
http://www.dphhs.mt.gov/publichealth/epidemiology/documents/
GallatinCommunityHealthAssessments.pdf
December 2010 http://www.healthypeople.gov. [objectives IID-7.1-7.6]
Pertussis rates per 100,000
Pertussis, or whooping cough,
is transmitted through person-to-person contact and
can be prevented through
high level vaccination coverage, especially that of
vulnerable populations.
Sources: Montana Department
of Public Health and Human
Services Communicable Disease
Program
(2006-2008 Annual
Average Cases per
100,000 Population)
6
4
5
4.4
Gallatin
County
US
Clinical care and access
•
49
Clinical Care
and Access
insurance and access
Percent ages 18-64 who lack health insurance
50%
While Gallatin County’s uninsured coverage is not drastically different from the rest of the state, there is still over 1
in 5 people who are without health insurance. The healthy
people 2020 target is universal coverage (0% uninsured).
Residents living below the 200% of the federal poverty threshold experience much higher underinsurance
prevalence- 42.7%.
30%
40%
20%
10%
0%
22.1%
44.1%
22.6%
14.9%
Gallatin
County
Below 200%
FPL, in
Gallatin County
Montana
US
Percent difficulty accessing healthcare in the past year (composite)
Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. It
impacts: overall physical, social, and mental health status; prevention of disease and
disability; detection and treatment of health conditions; quality of life; preventable
death; and life expectancy.
Access to health services means the timely use of personal health services to
achieve the best health outcomes. It requires three distinct steps: 1) Gaining entry
into the health care system; 2) Accessing a health care location where needed
services are provided; and 3) Finding a health care provider with whom the patient
can communicate and trust.
100%
More than one third (37.6%) of adults in Gallatin County report some type of
difficulty or delay in obtaining health care services in the past year.
Professional Research Consultants. PRC
National Health Survey. 2011.
80%
60%
40%
20%
37.6%
47.9%
37.3%
Gallatin
County
Below 200%
FPL, in
Gallatin County
US
0%
– Healthy People 2020 (www.healthypeople.gov)
50
•
oral health
Oral health is essential to overall health. Good oral health improves a person’s ability to speak, smile, smell, taste, touch,
chew, swallow, and make facial expressions to show feelings and emotions. However, oral diseases, from cavities to oral
cancer, cause pain and disability for many Americans. Good self-care, such as brushing with fluoride toothpaste, daily flossing, and professional treatment, is key to good oral health.
dental insurance
100%
80%
Only 45.5% of Gallatin County residents have dental insurance that covers all or
part of their dental care costs, which is lower than the national findings.
Professional Research Consultants, Inc. PRC National Health Survey. 2011.
60%
40%
20%
45.5%
29.9%
60.8%
Gallatin
County
Below 200%
FPL, in
Gallatin County
US
0%
Percent of adults (18+) who have visited the dentist in the past year
Barriers that can limit a person’s use
of preventive interventions and treatments include:
• Limited access to and availability of
dental services
• Lack of awareness of the need for
care
• Cost
• Fear of dental procedures
There are also social determinants
that affect oral health. In general,
people with lower levels of education
and income, and people from specific racial/ethnic groups, have higher
rates of disease. People with disabilities and other health conditions, like
diabetes, are more likely to have poor
oral health.
Healthy People 2020
100%
80%
60%
40%
20%
70.3%
61.1%
66.9%
Gallatin
County
Montana
US
0%
Sources: Professional Research Consultants, Inc. PRC Community Health Survey. [Item 21], Professional Research Consultants. PRC National Health
Survey. 2011. US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective OH-7]
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: US Department of Health and
Human Services, Centers for Disease Control and Prevention, 2008 Montana Data.
•
51
Clinical Care
and Access
prenatal care
Percent who received prenatal care in their first trimester
Improving the well-being of mothers, infants, and children is an important public
health goal for the US. Their well-being determines the health of the next generation
and can help predict future public health
challenges for families, communities, and
the healthcare system. The risk of maternal and infant mortality and pregnancyrelated complications can be reduced by
increasing access to quality preconception
(before pregnancy) and inter-conception
(between pregnancies) care. Moreover,
healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death
or disability and enable children to reach
their full potential. Many factors can affect
pregnancy and childbirth, including preconception health status, age, access to
52
•
appropriate healthcare, and poverty.
Infant and child health are similarly
influenced by socio-demographic factors,
such as family income, but are also linked
to the physical and mental health of parents and caregivers. There are racial and
ethnic disparities in mortality and morbidity for mothers and children, particularly
for African Americans. These differences
are likely the result of many factors, including social determinants (such as racial and
ethnic disparities in infant mortality; family income; educational attainment among
household members; and health insurance coverage) and physical determinants
(i.e., the health, nutrition, and behaviors
of the mother during pregnancy and early
childhood).
100%
Healthy People 2020
80%
60%
40%
20%
0%
86.3%
83.7%
Gallatin
County
US
Sources: Montana Department
of Public Health and Human
Services
US Department of Health and
Human Services. Healthy People
2020. December 2010 http://www.
healthypeople.gov. [Objective
MICH-10.1]
Note: Numbers are a percentage of all
live births within each population.
The US percentage is 2004-2006 data.
cancer screenings
Percent of women, ages 50-74 who have had a mammogram within the past year
Among women aged 50-74, 74.3% have had a mammogram
within the past two years.
• Similar to the statewide figure (which reflects all women
50+).
Healthy People 2020 Target=81.1% or Higher
100%
80%
60%
• Similar to national findings.
40%
• Fails to satisfy the Healthy People 2020 target (81.1% or
higher).
20%
• Women living below 200% of the Federal Poverty level are
significantly less likely to access mammogram screenings.
0%
74.3%
33.6%
70.9%
79.9%
Gallatin
County
Below 200%
FPL, in
Gallatin County
Montana*
US
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective C-17]
*Note that state data reflects all women 50 and older (compared with women 50-74 represented in the county and US figures.
Percent of women, age 21-65 who have had a Pap smear in the past 3 years
Among women age 21-65, 89.8% have had a Pap smear in the past 3 years.
• More favorable than the Montana
figure (which reflects all women 18+).
• Fails to satisfy the Healthy People
2020 target (93% or higher).
• Similar to national findings.
100%
Healthy People 2020
80%
60%
40%
Sources: Professional Research Consultants, Inc. PRC Community Health Survey. [Items 159]
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System
Survey. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease
Control and Prevention, 2010 Montana Data.
healthypeople.gov. [Objective C-15]
20%
89.8%
78.3%
84.7%
Gallatin
County
Montana*
US
0%
*Note that the Montana percentage represents all women aged 18 and older.
•
53
Clinical Care
and Access
Colorectal Cancer Screening
Percentage of respondents (over 50) who have ever had a sigmoidoscopy/colonoscopy exam
The evidence is convincing that
screening for colorectal cancer with
fecal occult blood testing, sigmoidoscopy, or colonoscopy detects earlystage cancer and adenomatous polyps. There is convincing evidence that
screening with any of the three recommended tests (FOBT, sigmoidoscopy,
colonoscopy) reduces colorectal cancer mortality in adults age 50 to 75
years. Follow-up of positive screening
test results requires colonoscopy regardless of the screening test used.
100%
– US Preventive Services Task Force, Agency for
Healthcare Research and Quality, US Department
of Health & Human Services.
20%
80%
60%
40%
67.0%
61.0%
72.0%
Gallatin
County
Montana
US
0%
BLOOD PRESSURE
Percentage of respondents who have had their blood pressure checked in the past 2 years
Controlling risk factors for heart disease
and stroke remains a challenge. High blood
pressure and cholesterol are still major
contributors to the national epidemic of
cardiovascular disease. High blood pressure affects approximately 1 in 3 adults in
the United States, and more than half of
Americans with high blood pressure do not
have it under control. High sodium intake
is a known risk factor for high blood pressure and heart disease, yet about 90% of
American adults exceed their recommendation for sodium intake.
100%
Healthy People 2020
80%
60%
40%
87.3%
94.7%
Gallatin
County
US
20%
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.
gov. [Objective HDS-4]
54
•
0%
BLOOD CHOLESTEROL
PERCENTAGE OF RESPONDENTS WHO Have had THEIR Blood
Cholesterol checked in the past 5 years
100%
80%
A total of 80.4% of total area adults have had their blood cholesterol checked
within the past five years.
60%
• More favorable than Montana
findings.
20%
• Similar to the Healthy People 2020
target (82.1% or higher).
Healthy People 2020
40%
80.2%
72.0%
90.7%
Gallatin
County
Montana
US
0%
• Less favorable than the national
findings.
US Department of Health and Human Services. Healthy People 2020. December 2010 http://www.healthypeople.gov. [Objective HDS-6]
mental health
Participants who have been diagnosed with major depression
A total of 8.7% of Total Area adults
have been diagnosed with major
depression by a physician or other
healthcare professional.
25%
20%
15%
10%
• Lower than the national finding.
5%
• Notably higher in Bozeman.
0%
10.9%
5.4%
9.0%
21.2%
11.7%
Bozeman
Other
Gallatin County
Gallatin
County
Below 200% FPL,
in Gallatin County
US
Sources: Professional Research Consultants, Inc. PRC Community Health Survey. [Item 33], Professional Research Consultants. PRC National Health
Survey. 2011.
•
55
health outcomes:
deaths (mortality)
In order to compare mortality in the region with other localities (in this case, Montana and the United States), it is necessary
to look at rates of death — these are figures which represent the number of deaths in relation to the population size (such
as deaths per 100,000 population, as is used here).
Furthermore, in order to compare localities without undue bias toward younger or older populations, the common
convention is to adjust the data to some common baseline age distribution. Use of these “age-adjusted” rates provides the
most valuable means of gauging mortality against benchmark data, as well as Healthy People 2020 targets.
chronic disease
Cancer (age adjusted
death rate)
Diabetes Melitus (age
adjusted death rate)
Diseases of the Heart (age
Cancer is the leading cause of death
in Gallatin County with 148.4 deaths
per 100,000.
Diabetes is the 7th leading cause of
death in the United States and the
9th leading cause of death in Gallatin
County.
Diseases of the heart are the 2nd leading cause of death in Montana.
(1999-2007 Annual Average
Deaths per 100,000 Population)
Healthy People 2020
Target=160.6 or Lower
200
50
150
40
100
30
148.4
185.8
189.5
Gallatin
County
Montana
US
10
Sources: Centers for Disease Control and
Prevention, Epidemiology Program Office,
Division of Public Health Surveillance and
Informatics. CDC WONDER Online Query
System. Data extracted August 2011.
www.healthypeople.gov. [Objective C-1]
56
•
200
150
100
50
20
0
Healthy People 2020
250
Healthy People 2020
250
50
144.5
185.5
228.2
Gallatin
County
Montana
US
0
15.4
23.8
24.5
Gallatin
County
Montana
US
0
www.healthypeople.gov. [Objective D-3]
Health outcomes: Deaths (Mortality)
www.healthypeople.gov. [Objective HDS-2]
Injury and Violence
Unintentional Injury (age
Firearm-Related Deaths
(age-adjusted mortality)
Motor Vehicle Crashes (age
Healthy People 2020
50
25
40
20
30
15
20
41.1
54.3
37.5
5
0
0
Montana
US
www.healthypeople.gov. [Objective IVP-11]
25
20
15
10
10
10
Gallatin
County
Healthy People 2020
Target=9.2 or Lower
Healthy People 2020
19.6
24.7
5
14.3
13.4
14.7
10.3
Gallatin
County
Montana
US
0
Gallatin
County
Montana
US
www.healthypeople.gov. [Objective IVP-30]
www.healthypeople.gov. [Objective IVP-13.1]
•
57
health outcomes:
deaths (mortality)
suicide
maternal & child health
Suicide (age-adjusted mortality)
Infant Mortality Rate
(1999-2007 Annual Average Infant Deaths per
1,000 Live Births)
Healthy People 2020
Healthy People 2020
Target=6.0 or Lower
50
10
40
8
30
6
20
4
10
2
0
17.3
19.3
10.8
Gallatin
County
Montana
US
Sources: Centers for Disease Control and Prevention, Epidemiology
Program Office, Division of Public Health Surveillance and Informatics.
CDC WONDER Online Query System. Data extracted August 2011.
December 2010 http://www.healthypeople.gov. [Objective MHMD-1]
58
•
6
6.2
7
Gallatin
County
Montana
US
0
Sources: Centers for Disease Control and Prevention, Epidemiology
Program Office, Division of Public Health Surveillance and Informatics.
CDC WONDER Online Query System. Data extracted August 2011.
December 2010 http://www.healthypeople.gov. [Objective MHMD-1]
health outcomes:
illness (morbidity)
quality of life
Percentage of “fair” or “poor” physical health
Healthy People 2020 Target=12% or Lower
100%
80%
60%
40%
20%
0%
14.2%
35.3%
71.0%
15.0%
16.8%
Gallatin
County
Below 200%
FPL, in
Gallatin County
Hispanic
population,
Gallatin County
Montana
US
Centers for Disease Control and Prevention
(CDC). Behavioral Risk Factor Surveillance
System Survey. Atlanta, Georgia: US
Department of Health and Human Services,
Centers for Disease Control and Prevention,
2010 Montana Data.
Professional Research Consultants. PRC
National Health Survey. 2011.
low birth weight
Percentage of low-weight births
Low birth weight babies, those who
weigh less than 2,500 grams (5 pounds,
8 ounces) at birth, are much more prone
to illness and neonatal death than are
babies of normal birth weight.
Largely a result of receiving poor
or inadequate prenatal care, many
low-weight births and the consequent
health problems are preventable.
Sources: Montana Department of Public Health and Human Services
healthypeople.gov. [Objective MICH-8.1]
(Percentage of Live Births,
2004-2008)
Healthy People 2020
Target=7.8% or Lower
10%
8%
6%
4%
2%
5.9%
7.0%
8.2%
Gallatin
County
Montana
US
0%
Health outcomes: illness (Morbidity)
•
59

community profile

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